Category Archive Self-Harm

ByAnxious Minds

Childhood Abuse and Depression – Anxiety Lives On

It has been established that nature and nurture should not be taken as enemies or total opposites, but as two intertwined realities that function together to make up the human experience. Nature was designed for nurture.

Many recent and notable studies have documented the effects that early childhood experience can have on both the physical and chemical makeup of the brain. In particular, childhood abuse and/or neglect can permanently alter an individual’s physiology. These physiological changes may lead to a greater likelihood of the person suffering from depression or anxiety later in life.

Groundbreaking results from a major study of depressed women in the US have shown that women who were abused as children have abnormally elevated hormonal responses to stress compared to women with no history of abuse. It suggests that childhood abuse is associated with persistent hyperactivity of the hormonal system associated with the stress response and this may cause greater vulnerability to psychiatric disorders in adulthood.

The study, headed by Dr. Charles Nemeroff at Emory University, looked at women diagnosed with clinical depression who had been abused as children; depressed women with no past abuse; and healthy women. Each person was given a moderately stressful experience and asked to perform simple mathematic problems aloud for a panel of stalwart non expressive judges.

Cortisol and ACTH (two hormones that play a critical role in a person’s response to stress) were measured in each subject while she completed the task. It was found that the levels of these hormones were especially pronounced in women who were abused as children and who also had current depression. In fact, their ACTH response indicators were more than six times those of the healthy women.

In addition to high levels of stress hormones, other studies by the same group found that women who had been abused as children had abnormal development of the brain’s hippocampus, which suggests another physical result of early abuse that could lead to permanent brain abnormalities in later life.

Other brain structures can also be affected by early abuse or neglect. While the basic unit of the brain is in place at birth, neuronal pathways for the body’s reaction to different experiences are still developing.

There is a critical period of time in a child’s first three years of life during which most of these pathways are formed. If a child receives primarily negative stimulation early in life, pathways for forming lasting relationships and responding to positive experiences can be stunted or destroyed. While this may be a reaction to help the child survive, it can cause permanent difficulties for the individual.

Other research shows that the brains of severely neglected children tend to be smaller than average with underdeveloped areas in the cortex. The long term implications of this are still being examined, but it shows one more way in which nurture or lack of it can affect a person’s biological make-up.

The knowledge that nature and nurture are two crucial aspects to a person’s health will undoubtedly prove to be a very useful tool in the research and treatment of psychiatric illness and may lead to even more effective treatments in the future.

Thank you
Dr Leo Kady

ByAnxious Minds

Self-harm

What is self-harm?
‘Self-harm’ refers to various behaviours that are used to deliberately cause a form of pain to the self. People who self-harm cause themselves physical pain as an unhealthy coping response to emotional pain; when people experience intense emotions from their mental health issues and do not know a healthy way to cope or express themselves, people may begin to use self-harming behaviours as a short-term quick fix.

The more that people use their self-harming techniques, the more they will rely on them to gain relief; however, this can become addictive and like other addictions, tolerance can begin to increase which will lead those people to increase the intensity of the self-harm behaviours – this can become dangerous. People learn to use these negative behaviours to ease their emotional pain, however, it is important to remember that all learned behaviours can be unlearned and replaced by more healthy and beneficial behaviours.

How do people self-harm?
People often only associate self-harm with one behaviour, cutting; however, there are many more things that people do to self-harm. There are other visible inflictions to the skin such as bruising, biting, scratching and burning, as well as pulling out hair and inserting objects into the body.

There are indirect ways of hurting the self, such as promiscuous behaviour, displaying aggression towards other with the intention of getting hurt, diet (e.g. binge eating or starving the self), alcohol or drug consumption and excessive exercise. Although these are common behaviours, there will be other ones used for the same purpose that may be unique to the individual.

Myths about self-harming
The most common myth is that self-harm is exclusive to cutting, as discussed in the ‘How do people self-harm?’ section.

Additionally, people often assume that those who self-harm are attempting suicide. Because people often assume that self-harm refers to cutting, it is also assumed that the cuts are intended to cause death. However, self-harming is mostly used for the complete opposite, it is a coping technique used to survive, not die; suicide would require one occasion of self-harm, whereas the majority of people who hurt themselves do it continuously to cope during day-to-day life.

Another myth is that only people who have been severely abused will self-harm; while it may be true that many people who have been abused will self-harm, it is not necessarily confined to those who have suffered in this way. Self-harm is used when the person does not know how else to cope with their emotions and therefore is used as a way of expressing themselves and coping.

Furthermore, self-harm is associated with ‘troubled teenagers’, the act of self-harm is a phrase that they will grow out of. Ongoing mental health issues may be intensified during early stages of adulthood, and for those who do not understand or have knowledge of what is happening to them, may resort to self-harming behaviours to cope with their symptoms. Unless the behaviour is stopped early on, it will continue through adulthood. Self-harm can begin at any age and usually starts during times where mental health issues first begin to appear, which for many will be during the teenage years.

One of the biggest myths about self-harm is that people only do it for attention. Self-harm is often a personal and private behaviour and those who engage in visible behaviours such as cutting, biting, burning, scratching etc. will often do it in private and on parts of the body that are not always visible, or if they are, will be covered up by clothing.

Also, those who indirectly hurt themselves may disguise what they are doing, for example, those who manipulate their diet or over exercise may mask the self-harm as a health interest.  However, there are those who do self-harm with the intention of gaining attention, but they should not be judged or criticised for it. As discussed, people who self-harm use these behaviours to cope or to express themselves; if people do not know how to ask for help for their mental health issues, they may hurt themselves in the hope that someone will notice that they are in pain and will offer to help.

Why do people self-harm?

It is often misunderstood why people self-harm, as previously mentioned the common assumption is that people do it as an attempt of suicide or for attention, however, there are many other reasons why people may engage in self-harm. For example, people self-harm because:

  • They are punishing themselves for either something they have done, said or felt, or for reasons that are out of their control but still blame themselves for;
  • The behaviour can change emotional pain into physical pain, which may seem easier to cope with. It can seem easier to treat a wound that it is to work on coping with intense mental health issues;
  • It can feel like a release of emotions and pain;
  • It can reduce feelings of numbness (this is often associated with depression; it may be better to feel pain than to feel nothing);
  • It can start off as a nervous habit, particularly behaviours such as hair pulling and scratching, which may then escalate into a routine response to stress;
  • They can watch their scars fade; people may make physical representations of their issues on their skin, and to watch the scars fade can almost feel like their issues can fade as well;
  • They may use it to distract their focus; instead of thinking about what is bothering them, they can distract themselves by focussing on the process and outcome of the behaviour;
  • People may acquire a sense of control from the behaviour, they are in control of their own pain;
  • It is a feeling that can become familiar, and that familiarity can bring a sense of comfort;
  • Some people experience some symptoms of mental health as a physical pain due to the physical responses to stress, therefore people may create pain to tell the difference between real physical pain and emotional pain presenting as physical;
  • They may blame other people for the pain they feel and so they present their self-harming behaviours to the world to show people that they have made them do this.

These are common reasons for self-harming, however, there will be other reasons as to why individuals self-harm that will be unique to them.

How to change the behaviours?
It is important to recognise that all forms of self-harm are learned behaviours; people who self-harm have learned that when they carry out these behaviours they gain something from it that brings comfort or a release from the symptoms of their mental health issues. Behaviours that can be learned can also be unlearned, therefore negative behaviours can be unlearned and replaced with positive and beneficial behaviours.

In order to stop these negative behaviours people have to first, understand that the behaviour does not reduce pain but just swaps one type of pain for another, this is a temporary fix that only adds to the suffering. Second, there are more beneficial and productive coping strategies that people can use to reduce negative emotions. For example, they can:

  • Alter their ritual of self-harming. This may include not taking out tools used or if they are walking towards a location where they typically self-harm, change direction;
  • Try finding an alternative way to occupy their mind, for example, doing something creative like drawing, painting or crafting. This allows them to occupy their hands and concentration as well as give them something physical that they have achieved and can be proud of;
  • Go for a walk and focus on what they can see, smell and feel. Sometimes when the mind is consumed with an issue, people can find comfort in reminding themselves what is real and what is not. It is easy to construct and inaccurately forecast negative outcomes of situations and misinterpret what has happened. By pointing out what is real it can serve as a contrast to what is not. Once people realise that the things worrying them may not be real, it can calm them down and help them make sense of the situation;
  • Seek an alternative and safe physical reaction. This can be done by doing things such as gripping ice or eating spicy foods such as chili pepper; these will provide a non-damage effect on the body but will still achieve a physical reaction;
  • Use a journal to help process what they are feeling. Writing can be a valuable tool that can help slow down thought processes and help people reason with the issues that have caused them distress. By writing about the situation and how they felt and responded to it may help people come to terms with the situation in a healthy way. It is not necessary for people to show others what they have written and if they prefer, they can destroy or delete it once they are finished with it. Writing acts as another way for people to express themselves that avoids harm.

Coping techniques are very personal to each individual; therefore, it is important for people to find out what works for them. Unlike self-harm, this is not a quick and temporary fix, it will take time and work, but work that will be gratifying and essential to living life with more ease.

Taking care of the injuries
Although it is much healthier to have alternative ways of coping, until the person can learn to use healthier behaviours, it is important that they understand how to take care of themselves in the process. For example, if someone’s way of self-harming is to damage the skin, then the wounds should be kept clean and routinely treated until they heal.

If the person manipulates their diet so that they eat more, make sure they exercise, or if they starve themselves, it is best to try and make sure they eat at least one meal every day. Or if they engage in promiscuous behaviour, make sure you are doing it in a safe environment and in a safe way. It is essential that if a person is going to engage in self-harming behaviours, they take care of themselves until they learn how to cope with their mental health issues in a positive way.

Finding alternative ways of coping can vary for each individual and may require some hard work on their part to be able to use new coping strategies effectively. However, the results from achieving learning positive coping strategies are much more beneficial than the act of self-harm. If someone is struggling to find something that works for them, they may benefit from attending a peer support group or other support groups in their area, where peer-support workers and counsellors can help people through the process of recovering from self-harm.